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Butnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS a 4 <br /> 0 (` <br /> 1.1 vine (p1L- -780 <br /> 1 <br /> Tl <br /> OWNER %,Lk4� A r%A rnAGV RaL�e,I -c r TELEPHONE "7 1 5 W S_ 4 Q44 p <br /> Z <br /> HOME ADDRESS 9141 I1/fai� rsn.� �� on wa par^k MAI SSLl.1 � <br /> 0 <br /> EMERGENCY/FIRE NUMBER 2999 <br /> Q /� ROAD NAMERV (" .. <br /> OI -1 7? �wic_ Lkc_ ai <br /> LEGAL DESCRIPTION(see tax receipt) 1_t ��{�d t Yl (�p� U�S ��°I ( c <br /> DWELLING/BUILDING KI GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ "�� Cl) o <br /> TYPE OF PERMIT(S): Q v <br /> FILLING/GRADING>6 CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: CA i n ° I <br /> /� (Home/Cabin; CommercialC <br /> Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: /S tLbl49A YAIULEA1 Ph <br /> TI U <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 77 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 d <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). to 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE,LOT LINES. i O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N xJ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS I �, <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c <br /> O � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHENCr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. f <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. DD <br /> S -a and � L rn <br /> m <br /> 6. CL <br /> �_ <br /> 7. o y o 'o � <br /> X10) m <br /> Cr <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy off, ': a C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ) : m m ; m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am 1P <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. r <br /> m : <br /> m : <br /> SIGN HERE <br /> gnatuof owner or uil g contractor) (Id�a7te) <br /> ZONING ADMINISTRATOR <br /> ` ` ` <br /> w o <br /> WtA <br /> N Nalw " <br /> V <br /> fJ VI to O Vt V1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />